Question: 

My toddler sometimes gags on food, and it scares me. What should I do if he starts choking?

Answered by pediatrician Amissabah Kanley, MD:

It’s great that you are thinking ahead. Choking on food is one of the leading causes of injury in young children. Children under 3 are at highest risk because they don’t yet have the molars needed to chew certain foods. Here’s what every parent should know.

Which foods are choking hazards for young children?

Young children can’t chew certain foods thoroughly before swallowing, which makes some foods more dangerous than others. The ones I tell parents to watch out for most include:

• Whole grapes and large chunks of fruit
• Nuts and seeds
• Chunks of meat or cheese
• Hot dogs
• Popcorn
• Hard or sticky candy
• Chunks of raw vegetables

Avoid giving hard nuts to younger children altogether. If your child loves nuts, nut butters are a great alternative – they get the same great taste without the choking risk. For grapes and similar round foods, cut them into small, lengthwise pieces before serving.

If you eat nuts yourself, be extra cautious at home. It’s easy to drop a peanut on the floor when you have a little one cruising around. In the kitchen or any shared space, be mindful of keeping small foods out of reach.

What are the signs of choking?

Knowing the difference between gagging and choking is important. Gagging is noisy – your child is coughing and making sounds, which means air is moving. That’s the body doing its job. Choking is different. Watch for:

• Being unable to cough, breathe, cry or speak
• Face turning pale and blue-tinted
• Clutching at their throat

When a child goes quiet and can’t breathe, that’s a choking emergency. Have someone nearby call 911 immediately while you begin first aid.

What should I do if my child is choking?

If your child cannot cough, breathe, cry, or speak, call 911 immediately. If someone else is nearby, have them call while you begin choking first aid. Emergency responders can also guide you over the phone until help arrives.

• If your child is responsive: Give back blows followed by chest thrusts for a baby under 1, or abdominal thrusts for an older child. Because positioning and technique vary by age and size, caregivers should learn these skills through a first aid or basic life support course. Visit the American Red Cross choking resources page for more details.
• If your child is unresponsive: Start CPR. Knowing CPR can help you act quickly during the critical minutes before emergency responders arrive.

Why is basic life support training so important?

For families with young children, learning basic life support is one of the best investments you can make. Knowing what to do in those first minutes before a rescue team arrives can make all the difference.

The American Red Cross offers life support training and detailed choking resources.

Parents often ask me about devices designed to help dislodge objects during choking. My honest answer is that the research is very mixed. If your child is choking, it is best to call 911 and start acting on your basic life support training right away – whether the child is responsive or unresponsive. 

Frequently asked questions

At what age can children eat these foods safely? 

Most high-risk foods can be introduced in modified forms once a child has their primary molars, typically around age 4. Talk to your child’s pediatrician about when and how to introduce higher-risk foods.

What is the difference between choking and gagging? 

Gagging is noisy and involves coughing – it’s the body’s normal reflex clearing the airway and usually resolves on its own. Choking is silent or near-silent, with little or no airflow. If your child is gagging loudly, watch closely but let them work through it. If they go quiet and can’t breathe, act immediately.

Should I call 911 or drive to the ER if my child is choking? 

Call 911. Emergency responders can provide guidance on the phone while they are en route, and driving while your child is choking is dangerous. Always call first.